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MIC Website Donation Form
Amount
*
$1,000
$500
$250
$100
$50
$25
$10
$
Donation Schedule (one time or recurring)
One Time
Monthly
Donor Information
Name
*
Prefix
First Name
Last Name
Suffix
Donor Type
*
I'm donating for myself
I'm donating for my congregation or organization
Congregation or Organization Name
Preferred Email
*
Verify Email
*
Phone
*
Phone type?
Home phone
Cell phone
Work phone
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Note or description:
Tribute Gift? if yes, provide name & address you'd like a card sent to:
Add 3% to my total amount to help cover the payment processing fees
